People adhere to the British government's social distancing guidelines as they queue to enter a Boots pharmacy store in York in northern England on March 30, 2020, as life in Britain continues during the nationwide lockdown to combat the novel coronavirus pandemic (Photo: OLI SCARFF/AFP via Getty Images).

NHS England will pay £300 to contractors “to support installation of physical barriers” in community pharmacies to help enforce social distancing.

This was announced in a letter from Chief Pharmaceutical Officer Keith Ridge to community pharmacists sent on Tuesday (March 31).

The letter, also signed by Primary Care Strategy and NHS Contracts Director Ed Waller, stated that this would help protect staff in pharmacies who “are understandably feeling very anxious about the risks to them at work.”

Personal protective equipment (PPE)

Stating that social distancing is most effective when enforced with bollards, physical barriers and screens, the letter advises pharmacies to follow the Public Health England’s (PHE) March 27 guidance on use of PPE – please see section 5.4, or pages 18 and 19 here.

The letter states: “Where more PPE is needed, pharmacies should be able to order it from their wholesalers for use by their staff only in line with the PHE guidance and not for resale.

“Stock is being made available to wholesalers.”

Meanwhile, the Pharmaceutical Services Negotiating Committee (PSNC) has said that it’s pressing the NHS to ensure that pharmacy teams have access to whatever PPE they need. It hopes that PHE will take a sensible approach and recognise the daily risks many pharmacies, particularly those that are not large enough to allow staff to stay two meters apart from one another, are taking as the public health body reviews its guidance on the use of PPE.

Care homes

To reduce risks, pharmacy teams have been advised to put measures in place if they need to visit a patient at their home (e.g. care homes or care at home). They have been asked to do all they can to shield care home residents from the virus, working with care home staff to establish systems to minimise the number of visits and only visit if it is necessary. Pharmacies could consider bulk prescribing in care homes for medicines like paracetamol.

Community Pharmacist Consultation Service (CPCS)

All referrals into CPCS via NHS 111 online have gone live across England, with patients now being advised to telephone rather than visit their local pharmacies. However, the letter states that any pharmacies that attempt to newly register for the service at this time will not be made live for the service because the work involved in the testing of new registrations has been de-prioritised.

Formula milk

In line with discouraging stockpiling, the letter now asks pharmacies to limit sales of formula milk to a “sensible quantity,” in the same way quantities of hand sanitisers, soaps and other over the counter medicines have been restricted per customer.

Community Pharmacy Standard Operating Procedure (SOP)

The letter also contains reminders of the community pharmacy SOP published on March 22 with updated guidance for pharmacy staff.

It refers to advice on making deliveries to those self-isolating, on collaborative working and the potential need to close pharmacy for up to 2.5 hours to allow staff to continue to dispense medicines safely.

The letter restates that community pharmacists and support staff, including delivery drivers, have been classified as “key workers” to access educational provision for their children.

Wholesalers and supply chain

Pharmacy teams have been asked to return any totes to their supplier’s delivery driver when they are making a delivery.

The lettered stated that a significant increase in the volume of orders due to the COVID-19 pandemic had left some distributors severely short of the totes required for deliveries, which was starting to affect the speed at which medicinal products could move through the supply chain.

It said that the Department of Health and Social Care was working closely with the supply chain to maintain the flow of medicines and reduce the likelihood of future shortages.

Electronic Repeat Dispensing (eRD)

Primary care is being asked to increase the use of electronic Repeat Dispensing (eRD) to better manage the situation with the NHS Business Services Authority helping GP practices to identify patients who may be appropriate for transfer to eRD.

NHS Digital is also working to expand electronic prescription service (EPS) to additional settings including GP hubs, paramedic prescribing and additional urgent care sites.

Contractors are encouraged to ensure that all staff requiring access to the national spine services, including EPS, the Patient Demographic Service (PDS) and the Summary Care Record (SCR), have active smartcards.

Treatment of COVID-19

Clinical trials are ongoing and being developed to assess the benefits of a number of different medicines in treating COVID-19. Suppliers of medicines being tested have been asked to monitor requests and restrict orders in line with historic ordering requirements.

The Medicines and Healthcare products Regulatory Agency (MHRA) have issued a press release highlighting that chloroquine and hydroxychloroquine are not licensed to treat COVID-19 related symptoms or prevent infection.

Pharmacists and GPs are asked to restrict prescriptions and supply to only those with current clinical need for licensed indications or as part of a clinical trial.

Capacity changes

Advising that the NHSE&I will be using the Directory of Services (DoS) data to monitor capacity changes within primary care associated with COVID-19, the letter asks pharmacies to continue to update their capacity status on their DoS profile.

They have also been asked to inform their local NHSE&I teams if there were any unavoidable closures and update the NHS website for patients and the public.

Conclusion

Acknowledging community pharmacy as “the NHS frontline for our response to COVID-19,” the NHS leaders have praised pharmacy teams “for stepping up in a truly professional way to the current demands.”

“We are doing all we can as quickly as we can to support you, and we urge you to follow the Government’s advice if you have any symptoms of COVID-19.”

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